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Anatomy 3001 > Diaphragm, mechanics of breathing, surface projections > Flashcards

Diaphragm, mechanics of breathing, surface projections Flashcards

1
Q

How would you describe the shape of the diaphragm?

A
  • Inverted J-shaped, both in the sagittal and transverse planes
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2
Q

Where does the diaphragm lie in full expiration?

A

4th/5th intercostal space

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3
Q

What does the diaphragm attach to anteriorly?

A
  • Xiphoid process of the sternum (at vertebral level T8/9)

- Deep surface of the last 6 ribs and costal cartilages (costal margin)

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4
Q

What is the crus of the diaphragm?

A

One of two tendinous structures that extends below the diaphragm to the vertebral column (means leg)

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5
Q

What does the diaphragm attach to posteriorly?

A 
- Lumbar vertebrae 
Left crus (L1-2)
Right crus (L1-3)
- Median arcuate ligament 
- Medial arcuate ligament 
- Lateral arcuate ligament
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6
Q

Where does the median arcuate ligament lie?

A
  • The midline
  • Between the crura
  • Surrounds aorta and forms aortic hiatus
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7
Q

Where does the medial arcuate ligament lie?

A
  • Body and transverse process of L1
  • Muscle fibres originate from the ligament
  • Arches over the psoas major muscle as it passes through the diaphragm
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8
Q

`Where does the lateral arcuate ligament lie?

A
  • Between the transverse process of L1 and the 12th rib
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9
Q

What level is the central tendon at anteriorly?

A

xiphosternal synchondrosis

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10
Q

What does the central tendon do?

A

Halts pericardial descent during insipiration

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11
Q

What passes through the caval opening?

A
  • Inferior vena cava

- Right phrenic nerve

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12
Q

What level is the caval opening at?

A

T8

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13
Q

What passes through the oesophageal opening?

A
  • Oesophagus
  • Both vagus nerves
  • Left gastric vessels (from abdomen to thorax)
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14
Q

What level is the oesophageal opening at?

A

T10, though the right crus (sphincter)

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15
Q

What passes through the aortic hiatus?

A
  • Aorta
  • Thoracic duct
  • Azygos and hemiazygos (+/-)
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16
Q

What does the sympathetic trunk pass behind?

A

The medial arcuate ligament

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17
Q

What passes through the crura

A
  • Branches of the phrenic nerve
  • Splanchnic nerves
  • Azygos and hemiazygos (+/-)
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18
Q

What does the diaphragm receive bllod from?

A
  • Superior phrenic artery (branch of thoracic aorta)
  • Branches of musculophrenic arteries
  • Branches of pericardiophrenic arteries
  • Inferior phrenic artery (branch of abdominal aorta)
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19
Q

What surface of the diaphragm is better supplied?

A

The superior side

20
Q

What nerve supplies the sensory fibres of the central tendon, parietal pleura and pericardium?

A

Phrenic nerve

21
Q

What nerve(s) supply the sensory fibres for the periphery of the diaphragm?

A
  • Intercostal nerves
22
Q

What is respiration?

A

Inspiration + Expiration

23
Q

What happens to the diameters of the thorax during inspiration, and how does this cause air to move into the lungs?

A

The diameters of the thorax increase creating a negative intra-thoracic pressure (

24
Q

How is expiration executed?

A

By muscle relaxation and elastic recoil of the elastic tissues in the lungs and bronchi

25
Q

What does contraction of the diaphragm cause?

A
  • Flattend the domes
  • Domes descend
  • The vertical diameter increases
  • Intrathoracic pressure decreases
  • Air is drawn into the lungs
26
Q

What percentage of air is inhaled due to the effects of the diaphragm?

A

70%

27
Q

1cm of descent of the diaphragm causes how large an increase in the volume of air in the lungs?

A

270 ml

28
Q

Describe the ‘pump-handle movement’?

A

As the body of the rib passes obliquely downwards
Contraction of the external intercostal muscles
To raise the body of the rib towards the one above
Also lifts the sternum and pushes it anteriorly
The anterior end of the rib needs to be lower than the posterior

29
Q

What happens to the diameter in pump handle movement?

A

The sagittal diameter increases

30
Q

Describe ‘bucket-handle’ movement?

A
  • As the costal cartilages of ribs 5-10 pass obliquely upwards to the sternum, contraction of the external intercostal muscles also lifts them and displacing the rib laterally?
31
Q

What happens to the diameter in ‘bucket-handle’ movement?

A

The transverse diameter increases

32
Q

What ribs are affected by forced inspiration?

A

8-10 (only in ribs that have flat costo-transverse joints that allow gliding. They evert

33
Q

How do accessory muscles cause forced inspiration?

A

They cause a greater force of inspiration therefore creating a larger intrathoracic pressure. Also causes a small additional increase in the lateral thoracic diameter

34
Q

What are the accessroy muscles of respiration?

A
  • Pec maj and min (insp)
  • Lat dorsi (exp + insp)
  • Abdominal wall muscles (exp)
  • Neck and back muscles (trapezius, sternocleidomastoid, scalene muscles) help to fix ribs
35
Q

What are the points which make up the surface anatomy of the pleura?

A
  • 1st rib, 2 cm above clavicle
  • 2nd CC
  • 4th Lcc
  • 6th cc
  • 8th rib mid clavic
  • 10th rib mid axillary
  • T12 just below 12th rib
36
Q

What are the points which make up the surface anatomy of the lung?

A
  • 1st rib, 2 cm above clavicle
  • 2nd CC
  • 4th Lcc
    • 6th cc
    • 6th rib mid clavic
    • 8th rib mid ax
    • 10th rib mid scapular line and mid line
  • 2 spaces higher than pleura
37
Q

What are pleural recesses?

A
  • Potential spaces
  • Quiet respiration the lungs do not entirely fill the pleural cavities
  • Potential sites of accumulation of fluids from which they can be aspirated
38
Q

What is the surface tension?

A
  • Surface tension between the parietal and visceral pleurae “pulls” the visceral layer (and lung) with the movements of the thorax wall
  • Creates a slight negative pressure that maintains the lung in slight inflation even at the end of expiration
39
Q

What causes the lungs to ‘deflate’?

A

Elastic recoil

40
Q

What is inversely proprtional to elastic recoil?

A

Lung compliance

41
Q

What is the costodiaphragmatic recess?

A
  • Narrow potential space between the periphery of the diaphragm and the ribs
  • Lowest point of pleural cavity when patient upright
42
Q

What is the costomediastinal recess?

A

The potential space at the border of the mediastinal pleura and the costal pleura

43
Q

Where does the oblique fissure lie?

A
  • Curved line that begins between the spinous processes of the vertebra T3 and T4
  • Crosses the mid axillary line at the 5th intercostal space, and then follows the contour of rib 6
44
Q

Where does the horizontal fissure lie?

A

Follows the 4th intercostal space from the sternum until it meets the oblique fissure as it crosses rib 5

45
Q

Where is the triangle of safety?

A
  • Anterior border of the lat dorsi
  • Lateral border of pec makor
  • Horizontal level of nipple
  • Apex is below axilla
46
Q

What is flail chest?

A
  • Caused by severe trauma to the chest
  • Paradoxical respiration
  • Whole sternum floats freely
  • Two or more consequetive ribs fractured at at least two or more locations

Anatomy 3001 (14 decks)

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